Intramedullary implant systems and methods

ABSTRACT

This disclosure describes exemplary intramedullary implant systems. The intramedullary implant systems may be used for performing bone fracture, bone fusion, or osteotomy procedures within joints.

CROSS-REFERENCE TO RELATED APPLICATION

This disclosure claims priority to U.S. Provisional Patent ApplicationNo. 62/718,656, which was filed on Aug. 14, 2018, the entire disclosureof which is incorporated herein by reference.

BACKGROUND

This disclosure relates to intramedullary implant systems and associatedsurgical methods.

A variety of surgical implants are used to treat bone abnormalities suchas fractures and bunions. For example, bone plates and intramedullarynails are commonly employed during orthopedic surgeries to stabilize,fuse, and/or align bones or bone fragments in order to restorefunctionality to a joint.

SUMMARY

This disclosure relates to intramedullary implant systems for performingbone fracture procedures, bone fusion procedures, osteotomy procedures,etc.

A first exemplary intramedullary implant system may include, inter alia,an implant including a plate portion and an integral intramedullaryportion, a locking screw received through an opening of the plateportion, and a crossing screw received through an additional opening ofthe plate portion or the integral intramedullary portion. The crossingscrew may extend at a non-perpendicular angle relative to a centerlineaxis of the implant.

Another exemplary intramedullary implant system may include an implantincluding a plate portion and an integral intramedullary portion. Talons(e.g., wings, barbs, claws, etc.) may be provided on the intramedullaryportion. The talons may be configured to deploy from a first position toa second position to increase stability of the implant relative to abone.

Another exemplary intramedullary implant system may include, inter alia,an implant that includes a plate portion and an integral intramedullaryportion. The implant may be made of a shape memory material.

Another exemplary intramedullary implant system may include, inter alia,an intramedullary nail, a plate, a washer, and first and second fixationdevices. The first fixation device may connect the plate to theintramedullary nail, and the second fixation device may connect thewasher to the intramedullary nail.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates a foot of the human musculoskeletal system. The footincludes a bone abnormality.

FIG. 2 illustrates an exemplary intramedullary implant system forcorrecting the bone abnormality of FIG. 1.

FIG. 3 further illustrates the intramedullary implant system of FIG. 2.

FIG. 4 illustrates another exemplary intramedullary implant system forcorrecting a bone abnormality.

FIG. 5 further illustrates the intramedullary implant system of FIG. 4.

FIG. 6 illustrates yet another intramedullary implant system forcorrecting a bone abnormality.

FIG. 7 further illustrates the intramedullary implant system of FIG. 6.

FIG. 8 illustrates yet another intramedullary implant system forcorrecting a bone abnormality.

FIGS. 9A and 9B further illustrate the intramedullary implant system ofFIG. 8.

FIG. 10 illustrates an intramedullary implant system for repairinganother bone abnormality.

FIG. 11 further illustrates the intramedullary implant system of FIG.10.

FIG. 12 illustrates various designs of an intramedullary nail of theintramedullary implant system of FIGS. 10-11.

FIGS. 13A and 13B illustrate an exemplary plate of the intramedullaryimplant system of FIGS. 10-11.

FIGS. 14A and 14B illustrate an exemplary washer of the intramedullaryimplant system of FIGS. 10-11.

FIGS. 15A and 15B illustrate another exemplary washer of theintramedullary implant system of FIGS. 10-11.

DETAILED DESCRIPTION

This disclosure describes exemplary intramedullary implant systems forperforming bone fracture, bone fusion, or osteotomy procedures withinjoints.

A first exemplary intramedullary implant system may include, inter alia,an implant including a plate portion and an integral intramedullaryportion, a locking screw received through an opening of the plateportion, and a crossing screw received through an additional opening ofthe plate portion or the integral intramedullary portion. The crossingscrew may extend at a non-perpendicular angle relative to a centerlineaxis of the implant.

In a further embodiment, talons are provided on an integralintramedullary portion of an implant. The talons are configured todeploy from a first position to a second position to increase stabilityof the implant relative to a bone.

In a further embodiment, talons are provided on a proximal portion of anintegral intramedullary portion of an implant.

In a further embodiment, talons of an integral intramedullary implantportion of an implant include deployable wings, barbs, claws, or anycombinations thereof.

In a further embodiment, a plate portion is laterally offset from anintegral intramedullary portion of an implant.

In a further embodiment, a centerline axis of an implant is non-linear.

In a further embodiment, portions of a plate portion of an implant, anintegral intramedullary portion of the implant, or both are curved.

In a further embodiment, an integral intramedullary portion of animplant is configured in the shape of a nail body. An additional openingis formed through the nail body for receiving a crossing screw.

In a further embodiment, a plate portion and an integral intramedullaryportion of an implant are comprised of a shape memory material.

In a further embodiment, a shape memory material of an implant includesNitinol, and a centerline axis of the implant is curved.

In a further embodiment, a tab protrudes from an integral intramedullaryportion of an implant near a junction between the integralintramedullary portion and a plate portion of the implant. An additionalopening is formed through the tab for receiving a crossing screw.

Another exemplary intramedullary implant system may include, inter alia,an intramedullary nail, a plate, a washer, and first and second fixationdevices. The first fixation device may connect the plate to theintramedullary nail, and the second fixation device may connect thewasher to the intramedullary nail.

In a further embodiment, a third fixation device extends through anintramedullary nail but is unconnected to either a plate or a washer ofan intramedullary implant system.

In a further embodiment, a plate of an intramedullary implant systemincludes a groove located on a bone facing surface of the plate, anopening for receiving a first fixation device, and a suture holeconfigured for receiving a suture, filament, or other thread-likematerial.

In a further embodiment, a washer of an intramedullary implant systemincludes a central opening for receiving the second fixation device anda plurality of suture holes surrounding the central opening andconfigured for receiving a suture, filament, or other thread-likematerial.

FIG. 1 schematically illustrates portions of a foot 10 of the humanmusculoskeletal system. A forefoot 12 of the foot 10 is specificallyshown. The forefoot 12 includes multiples phalanges 14 (i.e., toes) andmultiples metatarsals 16 located proximal to the phalanges 14. Asillustrated, the foot 10 includes a bone abnormality 18. In anembodiment, the bone abnormality 18 is a hallux valgus abnormality (alsoreferred to as a bunion abnormality) in which there is a medialdeviation of the first metatarsal 16-1 and a lateral deviation of thefirst phalanges 14-1. If not corrected, the bone abnormality 18 can leadto pain and arthritis.

FIGS. 2-3 illustrate an intramedullary implant system 20 for repairingthe bone abnormality 18 of FIG. 1. The intramedullary implant system 20may include an implant 22 and a multitude of fixation devices 24 (e.g.,screws, pegs, etc.). The total number of fixation devices 24 utilizedwithin the intramedullary implant system 20 is not intended to limitthis disclosure.

The implant 22 may include a plate portion 26 and an intramedullaryportion 28. In an embodiment, the plate portion 26 and theintramedullary portion 28 are integrated to establish a single-piecestructure. Stated another way, the implant 22 may be a monolithic devicewithout any mechanical attachments for connecting the plate portion 26and the intramedullary portion 28 together.

The intramedullary portion 28, which may be configured in the shape of anail body, may extend along a longitudinal centerline axis A between aproximal portion 30 and a distal portion 32. The plate portion 26 mayinclude any size and shape. The distal portion 32 connects to the plateportion 26 of the implant 22, whereas the proximal portion 30 isdisposed at an opposite end of the intramedullary portion 28 from theplate portion 26.

In an embodiment, the plate portion 26 is offset from the intramedullaryportion 28. For example, the plate portion 26 may be laterally offsetfrom the longitudinal centerline axis A of the intramedullary portion.The offset between the plate portion 26 and the intramedullary portion28 can be any offset distance within the scope of this disclosure (e.g.,3 mm, 5 mm, 7 mm, 10 mm, etc.).

The plate portion 26, the intramedullary portion 28, or both may includeopenings for receiving the fixation devices 24. In an embodiment, theplate portion 26 includes a first opening 34A for receiving a firstfixation device 24A, a second opening 34B for receiving a secondfixation device 24B, and a third opening 34C for receiving a thirdfixation device 24C. The first and second fixation devices 24A and 24Bmay be locking screws and the third fixation device 24C may be acrossing screw, in an embodiment.

In another embodiment, the intramedullary portion 28 of the implant 22includes one or more deployable talons 36. The talons 36 may beconfigured as deployable wings, barbs, claws, etc. that extend from theimplant 22 to enhance the intramedullary boney fixation. The talons 36may also provide rotational stability once deployed. During removal, thetalons 36 may be retracted to safely remove the implant 22 from theintramedullary canal.

The talons 36 may be selectively deployed between a first position X anda second positon X′ (shown in phantom in FIG. 3). In the deployedpositon X′, the talons 36 grip surrounding bone and therefore improvestabilization of the implant 22 relative to the bone.

The talons 36 may be deployed between the first position X and thesecond position X′ using an external driver (not shown) that is affixedto the implant 22 post insertion. In an embodiment, the external drivermay engage an end of the intramedullary portion 28 of the implant 22that is opposite from the talons 36 in order to be affixed to theimplant 22. Turning the external driver in a first direction (e.g.,clockwise) may deploy the talons 36 in a controlled manner. An audibleclicking noise may be emitted to signify that the talons 36 have fullydeployed to the second position X′. During removal, the external drivermay be affixed to the implant 22 and then rotated in a second direction(e.g., counterclockwise) to retract the talons 36 back to the firstposition X. the implant 22 may then be safely removed without damagingthe surrounding bone.

The implant 22, including the plate portion 26 and the intramedullaryportion 28, may be made from any biocompatible material or combinationsof biocompatible materials. Exemplary materials include, but are notlimited to, titanium, titanium alloys, stainless steel, andthermoplastic materials.

With primary reference to FIG. 2, an exemplary surgical method to repairthe bone abnormality 18 using the intramedullary implant system 20 mayinclude the following non-limiting steps. After first exposing the firstmetatarsal 16-1, an osteotomy may be performed to divide the firstmetatarsal 16-1 into a distal segment 38 and a proximal segment 40. Thedistal segment 38 is then shifted in a direction toward the secondmetatarsal 16-2. Next, a intramedullary passage 42 may be drilled intothe proximal segment 40 of the first metatarsal 16-1. The intramedullaryportion 28 of the implant 22 may then be inserted into theintramedullary passage 42.

The plate portion 26 is then positioned against an external surface ofthe distal segment 38, and the fixation devices 24 may then be insertedthrough the openings 34 of the implant 22 and into the distal segment38, the proximal segment 40, or both. In an embodiment, the thirdfixation device 24C extends at a transverse angle relative to thelongitudinal centerline axis A of the intramedullary portion 28.Finally, the talons 36 of the intramedullary portion 28 may be deployedin order to enhance fixation and stabilization of the implant 22relative to the first metatarsal 16-1.

FIGS. 4-5 illustrate another exemplary intramedullary implant system 44for repairing a bone abnormality, such as the bone abnormality 18 ofFIG. 1. The intramedullary implant system 44 may include an implant 46and a multitude of fixation devices 48 (e.g., screws, pegs, etc.).

The implant 46 may include a plate portion 50 and an integralintramedullary portion 52. In an embodiment, the plate portion 50 andthe intramedullary portion 52 are integrated together as a single-piecestructure. The implant 46 may be a monolithic device without anymechanical attachments for connecting the plate portion 50 and theintramedullary portion 52 together.

The implant 46 may extend along a centerline axis A. In an embodiment,the centerline axis A is non-linear, and thus, portions of the plateportion 50, the intramedullary portion 52, or both may be curved. Thecurvature of the implant 46 simplifies the ability to effect themetatarsal shift between the distal segment 38 and the proximal segment40 of the first metatarsal 16-1 in order to repair the bone abnormality.

The intramedullary portion 52 of the implant 46 may extend between aproximal portion 54 and a distal portion 56. The distal portion 56connects to the plate portion 50 of the implant 46, whereas the proximalportion 54 is disposed at an opposite end of the intramedullary portion52 from the plate portion 50. Once implanted, the plate portion 50 isreceived against an external surface of the bone and therefore is an“extramedullary” component of the implant 46.

The plate portion 50, the intramedullary portion 52, or both may includeopenings for receiving the fixation devices 48. In an embodiment, theplate portion includes a first opening 58A for receiving a firstfixation device 48A, a second opening 58B for receiving a secondfixation device 48B, and a third opening 58C for receiving a thirdfixation device 48C. The first and second fixation devices 48A and 48Bmay be locking screws and the third fixation device 48C may be acrossing screw, in an embodiment.

In another embodiment, the intramedullary portion 52 of the implant 46includes one or more deployable talons 60. The talons 60 may beselectively deployed between a first position X and a second positon X′(shown in phantom in FIG. 5). In the deployed positon X′, the talons 60grip surrounding bone and therefore improve stabilization of the implant46 relative to the bone.

FIGS. 6-7 illustrate another exemplary intramedullary implant system 62for repairing a bone abnormality. The intramedullary implant system 62is similar to the intramedullary implant system 20 of FIGS. 2-3 andincludes an implant 64 and fixation devices 66. However, in thisembodiment, the implant 64 of the intramedullary implant system 62 lackstalons.

The implant 64 may include a plate portion 68 and an integralintramedullary portion 70. The intramedullary portion 70, which may beconfigured in the shape of a nail body, may extend along a longitudinalcenterline axis A between a proximal portion 72 and a distal portion 74.The plate portion 68 may include any size and shape. The distal portion74 connects to the plate portion 68 of the implant 64, whereas theproximal portion 72 is disposed at an opposite end of the intramedullaryportion 70 from the plate portion 68. Once implanted, the plate portion68 is received against an external surface of the bone and is thereforean “extramedullary” component of the implant 64.

In an embodiment, the plate portion 68 is offset from the intramedullaryportion 70. For example, the plate portion 68 may be laterally offsetfrom the longitudinal centerline axis A of the intramedullary portion70. The offset between the plate portion 68 and the intramedullaryportion 70 can be any offset distance within the scope of thisdisclosure (e.g., 3 mm, 5 mm, 7 mm, 10 mm, etc.).

In an embodiment, the plate portion 68 includes a first opening 76A forreceiving a first fixation device 66A and a second opening 76B forreceiving a second fixation device 66B, and the intramedullary portion70 includes a third opening 76C for receiving a third fixation device66C. The first and second fixation devices 66A and 66B may be lockingscrews and the third fixation device 66C may be a crossing screw, in anembodiment. The total numbers of openings and fixation devices of theintramedullary implant system 62 are not intended to limit thisdisclosure.

FIGS. 8, 9A, and 9B illustrate yet another exemplary intramedullaryimplant system 78 for repairing a bone abnormality. The intramedullaryimplant system 78 may include an implant 80 and a multitude of fixationdevices 82 (e.g., screws, pegs, etc.) for fixating the implant 80relative to bone, such as the first metatarsal 16-1.

The implant 80 of the intramedullary implant system 78 may be made froma shape memory material (e.g., material or materials capable ofexhibiting superelasticity and/or a temperature-induced shape changes).In a first embodiment, the implant 80 is made of a metal alloy, such asNitinol (NiTi). In another embodiment, the implant 80 is made of apolymer, such as an appropriately processed polyether ether ketone(PEEK). By virtue of its material make-up, the implant 80 can generate acompressive load in order to realign bones or bone segments at desiredpositions relative to one another and can maintain the compressive loadwhile healing occurs.

The implant 80 may include a plate portion 84 and an integralintramedullary portion 86. Once implanted, the plate portion 84 isreceived against an external surface of a bone, such as a distal segment38 of the first metatarsal 16-1, and is therefore an “extramedullary”component of the implant 80, and the intramedullary portion 86 may beinserted within an intramedullary passage 42 of a bone, such as aproximal segment 40 of the first metatarsal 16-1.

The implant 80 may extend along a centerline axis A. In an embodiment,the centerline axis A is curved. In combination with the shape memorymaterial, the curvature of the implant 80 simplifies the ability toeffect the metatarsal shift between the distal segment 38 and theproximal segment 40 of the first metatarsal 16-1 when repairing the boneabnormality.

The plate portion 84 may include a first opening 88A for receiving afirst fixation device 82A and a second opening 88B for receiving asecond fixation device 82B. The first and second fixation devices 82Aand 82B may be locking screws, in an embodiment.

The intramedullary portion 86 may include a third opening 88C forreceiving a third fixation device 82C. The third fixation device 82C maybe a crossing screw, in an embodiment. The total numbers of openings andfixation devices of the intramedullary implant system 78 are notintended to limit this disclosure.

In another embodiment, the intramedullary portion 86 of the implant 80includes a tab 90 that protrudes from the intramedullary portion 86 neara junction between the intramedullary portion 86 and the plate portion84. The tab 90 may function to fill portions of an intramedullarypassage 42 formed in the proximal segment 40 for accommodating theintramedullary portion 86. The third opening 88C may extend through thetab 90. Therefore, once inserted, the third fixation device 82C may befixated through the tab 90.

FIGS. 10-11 illustrate an exemplary intramedullary implant system 92 forrepairing another bone abnormality 94 of a bone 96. In this embodiment,the bone abnormality 94 includes a fracture. The bone 96 may be ahumerus or any other long bone. Although shown proximally, the fracturecould be located anywhere on the bone 96.

The intramedullary implant system 92 may include an intramedullary nail98, one or more plates 100, one or more washers 102, and a plurality offixation devices 104. The total numbers of plates 100, washers 102, andfixation devices 104 used within the intramedullary implant system 92are not intended to limit this disclosure.

The intramedullary nail 98 may include a cannulated body 106 thatextends along a longitudinal centerline axis A between a proximalportion 108 and a distal portion 110. The proximal portion 108 mayinclude a first plurality of openings 114A (e.g., holes or slots) foraccommodating the fixation devices 104, and the distal portion 110 mayinclude a second plurality of openings 114B for accommodating thefixation devices 104. In general, one fixation device 104 may bereceived through each opening 114A, 114B. However, it is not necessaryfor each opening 114A, 114B to be utilized during a given surgicalprocedure.

The intramedullary nail 98 may embody various configurations. In anembodiment, the cannulated body 106 of the intramedullary nail 98 iscompletely straight along the longitudinal axis (see picture (a) of FIG.12). In another embodiment, the proximal portion 108 of the cannulatedbody 106 is angled relative to the distal portion 110 to establish aslight bend 115 in the intramedullary nail 98 (see picture (b) of FIG.12). In addition, depending on the size of the bone 96, theintramedullary nail 98 could include a small size (see pictures (a) and(b) of FIG. 12), a medium size (see picture (c) of FIG. 12), or a largesize (see picture (d) of FIG. 12).

Once implanted in the bone 96, at least a portion of the intramedullarynail 98 may extend across a facture line 112 of the fracture. In theillustrated embodiment, a portion of the proximal portion 108 extendsacross the fracture line 112. However, this will ultimately depend onthe location of the fracture and the type of bone, among other factors.

One or more of the plates 100 may be utilized in conjunction with theintramedullary nail 98 in order to augment the fracture fixation. Theplate 100 may include any size or shape (an exemplary plate 100 designis shown in FIGS. 13A and 13B).

The plate 100 may optionally include a groove 105 for allowing thebending/molding of the plate 100 to sit flush on differing boneanatomies or in differing bone locations. In an embodiment, the groove105 is located on a bone facing surface 107 of the plate 100.

The plate 100 may additionally include a plurality of openings 116 thatare configured to receive one of the fixation devices 104. In anembodiment, a fixation device 104A may be received within one of theopenings 116 of the plate 100 and within one of the openings 114A, 114Bof the intramedullary nail 98. The fixation devices 104A thereby locksthe intramedullary nail 98 and the plate 100 together. Once lockedtogether, the plate 100 can be rotated as desired to better approximatea fractured segment of the bone 96 back to its anatomical location.Additional fixation devices 104B and 104C may then be inserted throughopenings 116 of the plate 100 and into the bone 96 to repair thefracture.

The plate 100 may additionally include one or more suture holes 118. Thesuture holes 118 are configured to receive a suture, filament, or someother threadlike material for assisting in repairing the fracture and/orfor tying tissue to the bone 96.

One or more of the washers 102 may additionally be utilized inconjunction with the intramedullary nail 98 in order to further augmentthe fracture repair. The washer 102 may include any size or shape. In afirst embodiment, the washer 102 is round (see FIGS. 14A and 14B). In asecond embodiment, the washer 102 is rectangular (see FIGS. 15A and15B). Other shapes are also contemplated within the scope of thisdisclosure.

The washer 102 may include a central opening 120 that is configured toreceive one of the fixation devices 104. In an embodiment, a fixationdevice 104D may be received within the central opening 120 and withinone of the openings 114A, 114B of the intramedullary nail 98. Thefixation devices 104D thereby locks the intramedullary nail 98 and thewasher 102 together for augmenting the fracture repair.

The washer 102 may additionally include one or more suture holes 122. Inan embodiment, the suture holes 122 surround the central opening 120.The suture holes 122 are configured to receive a suture, filament, orsome other threadlike material for assisting in repairing the fractureand/or for tying tissue to the bone 96.

An exemplary method for using the intramedullary implant system 92 torepair a fractured bone may include the following exemplary methodsteps. The intramedullary implant system 92 can be implanted usingpercutaneous or open reduction techniques. First, fragments of thefractured bone can be pinned together for initial fixation. Theintramedullary nail 98 may then be inserted into the bone using aradiolucent attachment which also functions as a guide for insertion ofthe fixation devices 104 and the plates 100 and washers 102. Fluoroscopycan be utilized to aid in final reduction of fracture fragments andassurance that the fixation devices 104 and plates 100/washers 102 arecorrectly placed to completely reduce the fracture fragments.

The intramedullary implant systems of this disclosure are configured fortreating various bone abnormalities. Non-limiting examples of boneabnormalities that may be treated include hallux valgus procedures,bunionectomies, fracture repairs, fusion (i.e., arthrodesis) repairs,etc.

Moreover, the systems described herein have referenced surgery inhumans. However, the implants of this disclosure can also be used inarthroplasty surgery in other animals, including but not limited to,dogs, horses, cats, cattle, etc.

Although the different non-limiting embodiments are illustrated ashaving specific components or steps, the embodiments of this disclosureare not limited to those particular combinations. It is possible to usesome of the components or features from any of the non-limitingembodiments in combination with features or components from any of theother non-limiting embodiments.

It should be understood that like reference numerals identifycorresponding or similar elements throughout the several drawings. Itshould further be understood that although a particular componentarrangement is disclosed and illustrated in these exemplary embodiments,other arrangements could also benefit from the teachings of thisdisclosure.

The foregoing description shall be interpreted as illustrative and notin any limiting sense. A worker of ordinary skill in the art wouldunderstand that certain modifications could come within the scope ofthis disclosure. For these reasons, the following claims should bestudied to determine the true scope and content of this disclosure.

1. An intramedullary implant system, comprising: an implant including aplate portion and an integral intramedullary portion; a locking screwreceived through an opening of the plate portion; and a crossing screwreceived through an additional opening of the plate portion or theintegral intramedullary portion, wherein the crossing screw extends at anon-perpendicular angle relative to a centerline axis of the implant. 2.The system as recited in claim 1, comprising talons provided on theintegral intramedullary portion and configured to deploy from a firstposition to a second position to increase stability of the implantrelative to a bone.
 3. The system as recited in claim 2, wherein thetalons are provided on a proximal portion of the integral intramedullaryportion.
 4. The system as recited in claim 2 or 3, wherein the talonsinclude deployable wings, barbs, claws, or any combinations thereof. 5.The system as recited in claim 1, wherein the plate portion is laterallyoffset from the integral intramedullary portion.
 6. The system asrecited in claim 1, wherein the centerline axis is non-linear.
 7. Thesystem as recited in claim 6, wherein portions of the plate portion, theintegral intramedullary portion, or both are curved.
 8. The system asrecited in claim 1, wherein the integral intramedullary portion isconfigured in the shape of a nail body, and the additional opening isformed through the nail body for receiving the crossing screw. 9.(canceled)
 10. (canceled)
 11. (canceled)
 12. (canceled)
 13. (canceled)14. (canceled)
 15. (canceled)
 16. The system as recited in claim 1,wherein the plate portion and the integral intramedullary portionestablish a single-piece structure of the implant.
 17. The system asrecited in claim 16, wherein the single-piece structure excludes anymechanical attachments for connecting the plate portion and the integralintramedullary portion together.
 18. The system as recited in claim 1,wherein at least a portion of the plate portion is curved.
 19. Thesystem as recited in claim 1, wherein at least a portion of the integralintramedullary portion is curved.
 20. The system as recited in claim 1,wherein at least a portion of both the plate portion and the integralintramedullary portion is curved.
 21. The system as recited in claim 1,wherein the plate portion establishes an extramedullary component of theimplant.
 22. The system as recited in claim 1, wherein the locking screwis received through the opening of the plate portion, the crossing screwis received through the additional opening of the plate portion, andcomprising a second locking screw received through a second additionalopening of the plate portion.
 23. The system as recited in claim 1,wherein the additional opening that receives the cross screw is aproximal-most opening of the plate portion.
 24. An intramedullaryimplant system, comprising: an implant comprising: a plate portion; anintramedullary portion; and a plurality of deployable talons provided onthe intramedullary portion, wherein the plurality of deployable talonsare movable between a retracted position and an expanded position,wherein the plurality of deployable talons include barbs, claws, or acombination of barbs and claws.